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Hi Mark and thank you for joining us today to talk about your area of expertise in the world of ophthalmology! Let’s dive straight into some questions to give our readers a much better insight into your profession and how you can help them.
These are all really positive surgeries that are all about improving vision or reversing some sort of vision deterioration with immediate feedback. I think it’s the immediacy of the feedback that is really key. We aren’t doing a surgery and hoping that our patient may get better in ten years time – they will be able to tell you the next day. Whilst it can be stressful, its immensely rewarding. There are so many new techniques such as DMEC or DSEC that are much more elegant and give the patient better outcomes.
I have been a consultant since 2006 and have been working at this level for a long time. Throughout my career, I have been continuously training and was working in ophthalmology as a junior for ten years prior to this. I have a lot of experience in the industry. I have been working in the corneal service since 2006 and tend to work with the seriously complicated corneal cases and this has also given me a wealth of experience. I have completed a lot of surgeries and laser, worked on some trials in lens surgery with FemtoFaco.
Most of the work for ICL’s is done in advance in terms of assessing my patient and choosing the correct lenses for the surgery. When you come to do the surgery the biggest thing you want for your patients is to feel relaxed. They are understandably nervous. The last thing you want is for your patient to be lying on the bed squeezing their eyes shut. It’s for this reason that I like to use intravenous sedation. I think it’s pretty essential, it relaxes the patient and makes the whole experience much more pleasant for them.
Over the years I’ve had a steady stream of patients who need laser eye surgery to sort out problems following cataract surgery. Typically instead of getting a prescription that gives them good distance vision without glasses they get a prescription that means that they need to wear glasses both for distance and for reading. There’s also often a difference in the prescription between the eyes which further adds to a sense of imbalance. By the time that they come to see me the patients are often quite frustrated having spent a lot of time being told to get used to the situation or told to wear glasses which they had been hoping to avoid. Laser eye surgery in these patients just sorts the problem out.
The first thing I consider is the patient’s prescription and age. ICL surgery is most suitable for patients who need glasses or contact lenses to see the distance clearly. They are not suitable for patients over 50 who need help with reading glasses. We then need to examine the patient, check that the eyes are healthy and ensure there is enough space inside the eye for the ICL to fit comfortably. Most short-sighted patients will have enough room – these are the patients with minus prescriptions. Unfortunately, there isn’t enough space for many hypermetropic or plus-prescription patients. Once you understand these two points, you need to make sure you have taken all the necessary measurements and then spend some time talking to the patient about the pros and cons of the procedure.
Although some patients choose to have an ICL even though they are suitable for laser, the majority of patients seeking ICL surgery cannot have laser. If you are not able to have an ICL, you may be able to have a partial correction of your prescription with a laser. For example, you could treat 80% of the prescription It is essential to simulate this with contact lenses before the surgery to give patients a better understanding of their vision post-op. Unfortunately, there will always be cases where you are just not able to offer a suitable procedure to improve your vision.
For patients with extremely limited vision, particularly those with only one eye, corneal graft surgery can lead to a profound improvement in vision. For patients who have very poor vision, it can mean the difference between being able to live independently and being dependent on others. Some patients with milder conditions, particularly those conditions that cause severe glare or halos will have real difficulties with driving a car or driving at night. Losing your ability to drive can profoundly affect your independence. I once had a patient who found everything had a considerable glare. She couldn’t use public transport and couldn’t drive as she wasn’t able to see the signs. She had given up going to work because she couldn’t see clearly. She was becoming really isolated.
Following her successful corneal graft (DMEK) surgery she is now out and about experiencing new cultures and meeting new people. These surgeries can have a hugely positive impact on people’s lives.
With ICL surgery, you’re often treating people with large prescriptions. So, if they have been -15, they are always thrilled with the results. For those with a -15 prescription, if you lose your glasses, you lose your sight – the world ends just 6cm from your eye. I recently had a patient whose prescription was around -20, it couldn’t be completely corrected, even with an ICL. So, I initially implanted ICLs, which brought her prescription down to -4. Three months after the ICL surgery, I corrected her -4 prescription with LASIK.
I think the most common one is that is somehow wears off in about five years’ time. I get asked that a lot, and it just doesn’t happen. You don’t start with a -6 prescription, go to 0 with a successful treatment and they come back four years later at a -6 again. Very occasionally, you get a patient whose prescription will drift a bit later; they may start at a -6, go to a 0 and come back at -0.5. If it does happen you can usually retreat the patient to get their vision back to how it had been after their initial treatment.
It’s also common for people to think they will never need glasses after laser eye surgery. Anyone with successful laser surgery will need glasses from the mid-40s onward, as our eyes naturally deteriorate with age.
Firstly, it’s important to understand why the surgery has been done. If there are conditions, for example, if you do a corneal transplant for a condition known as keratoconus, the grafts will last a long time. If you do a graft as an emergency and the eye is hot and infected, it’s unlikely to last a long time. Secondly, the type of technique is important. More modern surgeries like EK, DMEC and DSEC last a lot longer. Experience is also a factor, as it is with any profession, the more you do, the better you are at it. The patient-surgeon relationship is also vital. You have to want to see the patient, and the patient has to want to see you and feel comfortable with you. Finally, aftercare is paramount – the drops need to be used, and the patient needs to seek help when appropriate.
People are constantly trying to find ways of avoiding doing corneal transplants as this is a last-case surgery where possible. Scientists and surgeons are trying to grow the cells that line the back of the cornea, but this is still in its infancy stages and could take a long time.
There are various modifications of some of the graft techniques, including just peeling away some of the damaged cornea and using drugs to promote the existing cells to grow a healthy new layer – this technique is called DWEK.
One of my colleagues is doing genetic research, trying to find out why people get corneal problems in the first place.
Finally, EDoF lenses (extended depth of focus lenses) have been amazing in increasing the number of patients with a lens that gives them some near and distance vision – this research is really promising and quite exciting.
Thank you Mark for taking the time to speak with us today and to give your readers a much better understanding of your world of Ophthalmology!
If you have been denied Laser Eye Surgery and would like to discuss other potential treatment options with OCL, make an enquiry online or call on 0203 993 4268
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